Premature Ejaculation

What is premature ejaculation?

Premature ejaculation occurs when a man ejaculates earlier than desired, either by himself or by his partner, during sexual intercourse. It is a sexual problem that affects many men: up to 30% of men have experienced low intercourse time at some point in their lives. Although this does not qualify as premature ejaculation, it does indicate how common problems related to sexual control can be.

The definition of premature ejaculation is controversial and has changed over time. Different scientific societies have different diagnostic criteria, although the current commonly accepted criteria are three:

1. Coitus time less than 1 minute. Some scientific societies recommend different coitus times, with a maximum of 2 minutes.
2. Loss of control over when we reach orgasm.
3. The above two criteria should produce personal and interpersonal difficulty in our couple relationships.

There are some cultural determinants that may affect the number of men with premature ejaculation, such as ethnicity or cultural background. It is also accepted that premature ejaculation tends to decrease slightly during a man's lifetime.

Types of premature ejaculation

There are 4 types of premature ejaculation:

• Primary premature ejaculation. It is the one that occurs from the beginning of sexual intercourse. It is usually associated with low coitus times, around or less than 1 minute. Usually the cause of this problem is neurobiological and, therefore, genetic.
• Secondary premature ejaculation. It appears at some point in life, after years or decades of normal sexual control during intercourse. The main reasons for secondary premature ejaculation are urinary problems (urinary tract infections, prostate problems), thyroid problems, and also biographical changes or stressful situations (work problems, a new sexual partner, depressive-anxiety syndrome).
• Natural variable premature ejaculation. This is a variant of normal in which the man alternates sex of normal duration and control with other episodes in which coitus time and duration are low at his discretion.
• Pseudo premature ejaculation. It is generally considered a problem of expectation management, since it involves men who, despite having a normal - and often long - intercourse time, believe they have premature ejaculation.

Diagnosis

Premature ejaculation can be caused by both psychological and biological factors and its diagnosis is self-reported, i.e., it is made by the patient. Usually the intravaginal coital latency time (IELT) is used, together with a questionnaire, such as the PEDT (premature ejaculation diagnostic tool).

In cases of secondary premature ejaculation it is advisable to perform a study to rule out urinary problems (urine culture, urinalysis, PSA and free PSA) and thyroid (TSH, T3 and T4).

These questionnaires explore three areas. The first of these is the timing of intercourse. Next, the loss of control over the moment of orgasm is analyzed. Finally, it is determined whether the two previous factors have an impact on sexual relations and interpersonal relationships.

Solutions

Premature ejaculation can be treated with medication, psychological counseling, sexual techniques that delay ejaculation, pelvic floor toning, or a combination of these:

• Medication: Can be administered for primary premature ejaculation. There are two types of pharmacological strategies to treat premature ejaculation. First, we have topical treatments that are applied in the form of a spray. On the other hand, in selected cases, we can count on oral medications.
• Anxiety control: It is about accepting increasing doses of erotic stimulus through breathing exercises and cognitive mechanisms.
• Pelvic floor rehabilitation: Toning the pelvic floor has proven useful in the treatment of premature ejaculation, multiplying the time of coitus by 3. It is usually performed daily, performing exercises to enhance muscle tone.
• Sex therapy: This is the fundamental treatment for premature ejaculation. It consists of learning how the sexual response works in order to control it. In this sense, it is important to distinguish two concepts: the orgasmic point of no return and the stop and start exercise. The orgasmic point of no return is that moment which, once passed, triggers the orgasm-ejaculation complex. Identifying it is fundamental to be able to apply the start and stop exercise. At the point of no return, a stop is applied by means of pelvic floor contraction, inhibiting the orgasm-ejaculation and repressing sexual activity after decreasing arousal. This exercise, performed repeatedly, manages to "re-educate" the sexual response and lengthen the orgasm.